Black Mothers and Babies in the U.S. Are in a Life-or-Death Crisis

Tuesday marked the end of the inaugural Black Maternal Health Week, a campaign founded and led by the Black Mamas Matter Alliance. The effort was launched to build awareness and activism around the state of black maternal health in the U.S. Here are a few sobering statistics that underscore the need for such a campaign. The United States ranks 32nd out of the 35 wealthiest nations in infant mortality. Black infants are now more than twice as likely to die as white infants, a disparity greater than existed in 1850, 15 years before slavery ended. Each year, an estimated 700 to 900 maternal deaths occur in the U.S., which is one of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. And, according to the Centers for Disease Control, black women are three to four times as likely to die from pregnancy-related causes as their white counterparts.

Linda Villarosa talking:

when you go through the research—and I’m very interested in data and research—first, you have to look at all of the things that it is not. So you start to think, well, is it because black women are not taking care of themselves? But then there are studies that say, “Oh, even when prenatal care is the same, then still black women have low birth weight babies.” Then it’s sort of like, well, is there some kind of gene? Is there a genetic component? Then there are studies that say “No, actually.” Because when African immigrants and Caribbean immigrants come here, their babies are equal to white babies in size. But after a generation, then they start to look like African American babies, even when they are from the poorest countries. So after a while, it starts to just say, “Well, actually there is something else going on that has to do with being a black woman in America.”

It is race and racism. So it’s in two ways. One is just the lived experience of what happens to black women in the country has a physiological effect. There’s a wonderful researcher in the University of Michigan who coined the term “weathering.” I love the term because it is very poetic. So its says it’s like the weathering of a rock by the ocean. But it is also like the—weathering a storm, by a house, because it also speaks to resilience and resistance. But there’s a physiological effect.

So if you are stressed out—and I don’t mean, “Oh, I’m so stressed out”—the “lean in” kind of stressed out—but repeated insults to your psyche over and over and over again, it revs up your system so that it actually starts to wear you down. The internal systems of your body. So that’s part one of this, is the lived experience of being a black woman in America.

The second is the way black women are treated in the health care system. And I say black women, but I mean black people. And this has been something studied ad nauseam. I’ve read so many studies my eyeballs want to fall out, but it’s hard to get this across. A lot of people will say,”Oh, the Tuskegee experiment. That is what it is about.” And I said, “The Tuskegee experiment was years ago. We’re talking about people who are being mistreated, ill treated right now.”

If you combine the two and you take a woman who is essentially having a stress test to her body, which is pregnancy and childbirth, and you put her in this volatile situation where she is weathered and worn down by repeated insults, and then she is in a system that maybe is not out for her best interest, you get a volatile mix.

what really puts it into stark focus is what happened to Serena Williams. So Serena Williams had her baby in September.
And after the baby was born, she started complaining about having shortness of breath. She had a history of pulmonary embolisms, which is a blood clot in the lungs. So, she was ignored, and her concerns were not taken seriously, and it led to a crisis. Presumably, this is one of the richest women in the world, and one of the most proactive and one of the most powerful. But still, her legitimate concerns were ignored at a hospital.

– And she told the nurse exactly what she needed. She knew what she had. She said she needed a CT scan with contrast and IV heparin, a blood thinner, right away. The nurse thought her pain medicine might be making her confused. She insisted. Soon enough a doctor was performing an ultrasound on her legs. And you have the ultrasound revealing nothing, so they sent for a CT. Sure enough, several small blood clots had settled in her lungs. She was right. Minutes later she had the drip. And she said, “I was like ‘Listen to Dr. Williams.’” Yes. Please. The owner of your own body, that you know best.

What was interesting for me is I had read a study about college-educated women who have more—the higher rate of infant mortality, 75 percent related to low birth weight. So I’m thinking, “OK.” I didn’t believe it at first, because I was still under the assumption that this was strictly a problem of poor women. Which is wrong and terrible, but I still thought, “Well, OK, I see this.” But then when I got pregnant, I ended up—my baby was not progressing—was not large enough, given her gestational age.

So my wonderful gynecologist said, “You need to go on bed rest and you need to go to a specialist.”

So I went to the specialist, and the specialist was grilling me with all kinds of, “Do you use cocaine? Do you drink? Do you…?” And I’m the health editor of Essence magazine, so I am super into health, I’m very into fitness, I am trying to be a role model for good health and take care myself and my baby. So I was really insulted. “Do You have all of these different kinds of illnesses?” I’m, like, “No, I am fine.”

Then I looked up what I had, called intrauterine growth restriction, and it is something that is associated with women who are not taking care of themselves, smoking, drinking, using drugs, or ill. And so I thought, “What is wrong with me?” It turned out my baby was better not inside of me but on the outside, so I had her induced right at term. She was low birth weight. Low birth weight is 5.5 pounds. She was four pounds, 13 ounces.

She is fine now. She’s a healthy, smart, athletic college student. But I thought, is this because of my lived experience of being a black woman in America?


Simone Landrum, to me, is a hero. She has had a very hard life but is a very resilient person, really strong-willed, a good sense of humor, given what’s happened to her. So, she had two children, and then she got pregnant with a little girl, which she was really happy about. She really wanted to have a girl child. But she noticed that during this pregnancy, something was very different. So, first of all, she noticed swelling in her face and extreme headaches. So, every time she would tell her doctor that she had these headaches and they were worse than the usual headache, he would say, “Take Tylenol.” And she’d say, “No, my headache is quite bad.” And he’d say, “Take more.” So then she had a prenatal visit about six weeks before her due date, and the headache was extreme, and also her blood pressure spiked in the office. And so he said to her—she was, you know, upset. So he said to her, “You have two choices. Either we can take you upstairs to labor and delivery, and you can have this baby now”—which is not really feasible.

She was six weeks away from her delivery date. And then, “Or you can sit down and calm down, and we can try to get your blood pressure down.” And so she felt that that was disrespectful to her, that it was more about his convenience and his schedule. And so, what happened was, so she sat there, she got her blood pressure down, but four days later, she went into a crisis. She was in her car, and she thought her water had broken. And she looked down, and it was blood. So she got herself in an ambulance to the hospital, and she was basically bleeding out.

And the nurse put a monitor to her stomach, and there was no heartbeat to the baby. And so she realized that her baby had passed away and that she was in a crisis. She was dying, because of extreme blood loss. So they took the baby with a C-section. She survived; the baby didn’t. She had named the baby Harmony, and she passed away. So, then she got pregnant the next year, and she was determined not to have this happen again. And she was afraid, and so she ended up getting attached to a doula, Latona Giwa, who is another hero of this story.

a doula is a professional person who is with a woman during pregnancy, during labor and delivery and in the weeks after the baby is born, just to make sure—to advocate, to make sure that everything goes well, to be a source of information and also to be a source of support and comfort. And studies show that women who have worked with doulas have better pregnancy outcomes. So she got with this doula. And the good thing about this doula collective—it’s called Birthmark Doula Collective—is that they’re social justice- and birth justice-oriented, so they worked with her for free.

And so, she—so I came. I went to one of their early sessions, and I saw the most beautiful interaction between these two women. They’re very different. Latona’s very mellow, and Simone was very afraid. And she calmed her down. She talked her through. She talked about her prenatal visits, and she made a birth plan for her.

So, then, I was actually there most—a lot of the time. And her baby was due. The doctor was going to induce her on Thursday, because the pregnancy was going post-term. So, on Monday, we went in for the prenatal visit, and you saw on the screen that something was wrong, that the baby’s heart rate looked like chicken scratching. And the doctor called down to where she was having the test, and said, “We need to get the baby tonight. We need to take the baby today.”

So she got induced. Latona, the doula, came. She was wearing these cute little purple scrubs and had lavender oil and was just very calm. And it wasn’t—you know, it was kind of dramatic, but, in the end, Simone had a healthy baby. His name is Kingston Blessed, which is the perfect name for this child. And she also got to introduce this baby to her other two sons, who lost their little sister. And that was the moment, for many of us, that just felt like complete, very complete, complete in this woman’s life and complete this family’s life.

black infants now are more than twice as likely to die as white infants, which is a disparity that was greater than existed in 1850.

There were certainly more raw deaths—I mean, deaths—then. But if you look at these numbers—so, I actually looked at the numbers, and I said, “What would it mean if there was no disparity? If there was no black-white disparity, what would happen? How many people would be saved?” Four thousand babies, black babies, would be saved per year, if the disparity was closed.

I am not sure exactly why this has happened, but I—this is happening—but I am thinking that we really need to look much more closely at both the lived experience of being a black woman in America and what it does to our bodies, as well as the treatment women get in the hospital system. I think doulas and other birth workers are a solution for right now, as we grapple with changing the system, that is unfair to people of color. But I think doulas connect the technology that we have, and some of the best medical technology in the world, with caring and really taking care of people and putting caring back in healthcare.

And Latona Giwa only made $600 for everything she did. You know, I mean, it was from October until February, and they’re still in touch. And so, that really is wrong. And so we have to figure out how to pay doulas. We have to figure out how to incorporate them into the system and to make sure that it’s all woven together, because right now there’s a growing number of these kinds of social justice doulas, and it’s really beautiful to see this growing number of them and to see them trying to tackle these issues, but they’re kind of on their own. It’s a bit ad hoc. They’re not connected to systems. There are some that are connected to the medical systems in their city, here in New York City. We have a connection in some other cities, but it’s not national. It’s not nationalized.

certainly some doctors feel threatened, and, you know, there’s a conflict between doulas. But what I saw with Birthmark was a kind of sitting back, only taking action when necessary, being really by the birth mother’s side, and the focus was on her. But I also saw Latona take action, you know, when she needed to, but it was very calm and very nonthreatening, but it was firm.

the majority of physicians in this country, 75 percent, are white. And so, studies have shown that they do have biases. And how I look at it is, you know, not saying, “Oh, you went into the medical profession because you’re a big racist.” Everyone in this country has unconscious biases based on stereotypes that date back to slavery. But the solution is to really admit the biases, work on them, tackle them, say you have them, and how can you not bring those in to medical practices, to the medical setting. And that is what the key is, is to say, “Yes, these exist, but we’re going to work on that.”

And what I’ve seen is, in medical schools, you have younger medical students who are really trying to work on that. There’s this wonderful organization called White Coats for Black Justice, and there’s also groups around the country that are really trying. I received an email today about a young doctor who was saying, “I really want to get more woke and more organized about the kinds of inequities we see in healthcare.”

doulas go into this work that is not that well paid—doulas go into it for different reasons than doctors may go into it. From what I’ve seen, they are very into birth and very into women in a way, not the technology and not the medical part, but into the caring part.

at Birthmark, what they do is they have some women pay full freight. OK? So they pay the whole—I think it’s $1,500 or something like that. But then they use the money for the people who pay full price, and let the other women go—not pay. As well as grants. And, you know, they’re applying for grants. They’re doing fundraisers. They’re doing a fundraiser today, just trying to make money so that they can keep doing the work for women who need it and can’t pay.

I think that birth is supposed to be this beautiful thing that happens. It’s supposed to be natural. But the way we’ve medicalized it, the way we’ve criminalized it, is tragic in this country.

why I wanted to do it was because I knew about the numbers. So I had heard about the numbers, that it’s much more common in black women, maternal mortality and morbidity, the near death. So, for every woman who dies, a hundred women, like Simone Landrum, almost die. So I heard those statistics. But then I also knew about the statistics around infant mortality. So what I wanted to do was combine the two to say, “Wait, this is only one—you know, there’s one woman’s body who may die in childbirth, or her baby may die.” So it’s about her.

And so, I think the thing that surprised me most was when I went back to 1850, and I’m looking at that, and I was like, “Wait. How could this problem, the racial disparity, be greater during slavery, when black women were actually chattel, than it is now? And how could black women with an advanced degree have a higher incidence of either dying, almost dying in childbirth, or her baby dying, than a white woman with an eighth grade education?” So that was striking and startling.

But then you see it in what happens. I’ve gotten—since I’ve written this piece, I’ve gotten so many notes, letters, colleagues elbowing me, to tell me about what happened to them. Tearfully. And so, I was actually glad I shared my own story.

Arline Geronimus is a researcher at the University of Michigan, and she came up with the idea when she was a college student, undergraduate, at Princeton. So she was working at, I think, a school for unwed mothers, and she noticed that—she would go to their medical appointments with them, and she noticed that their bodies, when they took off their clothes, looked older than would be expected.

And then she started looking at infant mortality in those numbers, in those teens. Because what was interesting, at the time—and this is, I think, the ’80s—the blame on black infant mortality was on teen pregnancy. It was like because these teens, they’re irresponsible, they’re having babies, they are driving up the numbers of black infant mortality. What she found was actually the opposite, that it was slightly older black women who had higher rates of infant mortality. But the flip was true for white women, so white teens were driving up rates of infant mortality in whites.

So then she started thinking, “Oh, this is because they’ve lived longer. Black women have lived longer. They’ve had more access to stress, and it’s affecting their pregnancy outcomes.” And she has done—so that’s how she came up with the term “weathering.” But, you know, it’s real. It’s been well studied and been replicated. And I just love the term, because it really does say what it is. It’s your body is aging prematurely because of what’s happening to you.

And when you look at the, you know, sort of the questions, that—there’s a black women’s health study, and it added race questions in 1997. And the questions, it actually made me tear up, because the questions were like, “Oh, have you ever been treated differently because of your race?” “Do you think people think that they’re smarter than you?” “Have you had bad service at a restaurant because of your race?” And then there were hardcore questions like, “Have you been discriminated against at work, in housing and by the police?” And women who had higher rates of—reported rates of being discriminated against, whether it was big or small, had more preterm births.

– the statue of the gynecologist J. Marion Sims being taken down in Central Park, 19th century gynecologist, known as “the father of gynecology,” who repeatedly performed painful, nonconsensual scientific experiments on enslaved black women without anesthesia. The removal of the statue coming after repeated protests last year amidst the nationwide wave of demonstrations against Confederate monuments and other racist statues.

I guess what I’ll say about that is, thank God for activists who rallied to get rid of that, and goodbye, good riddance. That is a memory we don’t need to have and we don’t need to celebrate.

– The New York Times Magazine, titled “America’s Hidden H.I.V Epidemic: Why do America’s black gay and bisexual men have a higher H.I.V rate than any country in the world?” I want to read from the piece a quote: “Last year [in 2016], the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H.I.V. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of H.I.V., at 28.8 percent of the population. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation—and all other nations.”

I have been reporting on HIV since the ’80s. I was one of the first people to write for—excuse me—for an ethnic publication about HIV. So, at each point along this 30-year continuum, I kept thinking, “Oh my goodness, this is going to be over. This cannot—this epidemic”—and my focus is African Americans—”This will be over. This can’t keep going on.” Each time, “It’ll be over. It’ll be over.” So when I saw this one in two, that half of all black gay men could be infected in their lifetime, I was shocked.

And then, shortly after was another study that named the areas where gay men, in general, had the highest infection rate. And Jackson, Mississippi, was the number-one place. So, I just revved up all my sources and said, “Please help me understand why this is still going on in 2016”—at that point—”and why it’s Jackson, Mississippi.” This is—you know, I know Jackson, Mississippi, from the movie The Help and the best barbecue ever. So, what is happening there?

And so, everyone said, “You need to go down and see for yourself.” So I went to a conference called Saving Ourselves Symposium, and it was this beautiful gathering of black gay men, who I had never met most of them. They were doing work under the radar, really trying to, as they said, save themselves. Then I just rented a car. I drove—that was in Memphis. I drove to Jackson, Mississippi. And my family’s from Mississippi, so it was a beautiful trip for me personally.

And I saw, again, another kind of heroic person, called Cedric Sturdevant, who was basically an AIDS doula. He was going around helping men, getting medication, taking them to the doctor, taking them to all their clinic visits, really helping them, because there was a crisis there. And even when I was there, I saw newly infected men. I said, “When did you get infected?” I was there in September. And one young man said, “Oh, I found out in July.” While I was there, a transgender woman said, “I found out yesterday.” And so, it was shocking.

I also saw people who lacked treatment, and it wasn’t because they couldn’t get treatment. It was because the stigma was so high that they were afraid to even go get the treatment that they needed. And I just flashed right back to the ’80s. I flashed back to the ’80s, where people were sick, dropping dead in the street, and I thought, “What is happening in America, present-day America? This is just wrong.”

– Centers for Disease Control’s Morbidity and Mortality Weekly Report from June 5th, 1981

in that issue of that crazy, wonky newsletter—but it’s the voice of the CDC—it had five cases of men in Los Angeles, and they were previously healthy men who had contracted a very odd disease that was very much of a mystery. And that headline raced around, really, the country and, somewhat, the world.

But there were actually two other cases of men, and they were both black. So I went back to Dr. Michael Gottlieb, who I like a lot, and I said, “What is happening? Why didn’t you just report those last two cases?” And, you know, we had a really difficult but textured conversation. And he said, “They didn’t come in, in time. They came after the deadline for the publication.” And I said, “You know that could have made a difference.” And so then we really got into it.

And what he said was, “It was a hard time. It was a confusing time. Maybe I would have done something differently had I known what was going on, but people were dying. I was a doctor. I didn’t understand.” I celebrate this man now. He is still an HIV doctor in Los Angeles to this day. He still works with HIV-positive patients. So I don’t blame him. But that set the stage for a kind of erasure of the black experience in the epidemic.

I interviewed a lot of people, old-timers at the CDC and NIH. And what they said was it was just very difficult to even talk about HIV and AIDS, because it was so highly stigmatized by the government. And so people were trying to figure out how to talk about it without actually talking about sex.

And if scientists can’t talk openly about what they’re doing, then we really can’t get real information, and you really can’t get real data. And so, that was very strange. And then, George Bush II, what he did was he—I mean, he’s celebrated for this, and it’s wonderful that he focused on PEPFAR. So, PEPFAR was looking at the countries that were most infected around the world, and giving money to them, earmarking money to these countries. However, in the United States, the black community was saying, “Wait, where’s our PEPFAR? What is happening here? Why aren’t we getting money and attention? Where’s our AIDS strategy?” So, even though it was heroic and good that we looked out at what was happening in Africa, where the numbers were huge, we were forgotten here in the United States.

– PEPFAR being President’s Emergency Plan for AIDS Relief

Swaziland. the infection rate in black communities is so high, it does rival a place that is very poor, very small. They don’t have any of the same resources, most of the same resources we have. The highest rate of AIDS in the world, in Swaziland. And that was, admittedly, two years ago, so that might have changed. But still, at the time, that is crazy. That is wrong. What is—I mean, black gay men do not deserve this.

what struck me about the groups is that they have names that say, “We have given up on help from the country.” So, the Saving Ourselves Symposium says it all. My Brother’s Keeper was one of the groups that I followed down south. Cedric Sturdevant’s work was the SPOT; Safe Place Over Time is his new organization. So, he’s looking for a safe place. The Black AIDS Institute is—”Our People, Our Problem, Our Solution” is the tagline. Us Helping Us is an organization in Washington, D.C. And so, those names are saying, “We have given up. We have to wrap our arms around each other. We have to support each other. We’re doing this on our own and by ourselves.” But also there have been some initiatives, and there has been more money going toward HIV/AIDS in the South. Probably in the last year, you have seen an uptick in funding, because the funding is so mismatched that, I mean, really something had to change. Under Trump. Under the radar, under Trump.

Linda Villarosa
directs the journalism program at the City College of New York and is a contributing writer for the New York Times Magazine.

— source


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